← Back

Chapter 18: Antihypertensive and Antianginal Drugs

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 18: Antihypertensive and Antianginal Drugs

16 problems · 0 figures

Case Study 18.1.1 §18.1 source ↗

Table 18.2 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision. No difficulty hearing conversations.

• Cardiovascular: No jugular veindistention or pedal edema noted; S1, S2 heard on auscultation. Denies chest pain. Capillary refill brisk, mucous membranes pink and moist.

• Respiratory: Lungs clear to auscultation. States she does not experience shortness of breath and sleeps on one pillow. Has been told she snores but denies apnea.

• GI: Abdomen soft, nontender, nondistended; bowel sounds heard in all four quadrants. No report of nausea, vomiting, or abdominal pain. Has regular daily bowel movements.

• GU: Deferred.

• Neurological: Alert and oriented to time, place, person, and events. No reports of numbness, dizziness, vertigo, weakness, or seizures.

• Integumentary: No wounds noted; skin appropriate for age.
Blood pressure: 168/96 mm Hg
Heart rate: 88 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 97% on room air
Height: 5'3"
Weight: 184 lb

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Hahn Tran is a 53-year-old client who presents to her health care provider’s office with reports of a headache and dizziness. When questioned, she describes her headache as throbbing and that it is worse in the morning when she awakens. She is unable to identify any triggers for the headaches but states they are relieved with acetaminophen.

Hahn reports trying to follow a healthy diet but states that she does not really know what that means and that she uses a lot of salt in her cooking. She smokes about 6–8 cigarettes daily, which is down from one pack daily 3 months ago. Hahn does not exercise regularly and reports having 1–2 glasses of wine on the weekend. She lives with her husband and two teenage children and works in the kitchen at the children’s school.

History
Hyperlipidemia
Type 2 diabetes

Current Medications
Atorvastatin, 20 mg once daily
Metformin, 500 mg twice daily

Based on the assessment, what diagnosis should the nurse anticipate from the health care provider?
  1. a.
    Elevated blood pressure
  2. b.
    Hypertension stage 1
  3. c.
    Hypertension stage 2
  4. d.
    Hypertensive crisis

Answer

C. Hypertension stage 2
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).

Case Study 18.1.2 §18.1 source ↗

Table 18.2 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Denies any changes in vision. No difficulty hearing conversations.

• Cardiovascular: No jugular veindistention or pedal edema noted; S1, S2 heard on auscultation. Denies chest pain. Capillary refill brisk, mucous membranes pink and moist.

• Respiratory: Lungs clear to auscultation. States she does not experience shortness of breath and sleeps on one pillow. Has been told she snores but denies apnea.

• GI: Abdomen soft, nontender, nondistended; bowel sounds heard in all four quadrants. No report of nausea, vomiting, or abdominal pain. Has regular daily bowel movements.

• GU: Deferred.

• Neurological: Alert and oriented to time, place, person, and events. No reports of numbness, dizziness, vertigo, weakness, or seizures.

• Integumentary: No wounds noted; skin appropriate for age.
Blood pressure: 168/96 mm Hg
Heart rate: 88 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 97% on room air
Height: 5'3"
Weight: 184 lb

Read the following clinical scenario to answer the questions that follow. This case study will evolve throughout the chapter.

Hahn Tran is a 53-year-old client who presents to her health care provider’s office with reports of a headache and dizziness. When questioned, she describes her headache as throbbing and that it is worse in the morning when she awakens. She is unable to identify any triggers for the headaches but states they are relieved with acetaminophen.

Hahn reports trying to follow a healthy diet but states that she does not really know what that means and that she uses a lot of salt in her cooking. She smokes about 6–8 cigarettes daily, which is down from one pack daily 3 months ago. Hahn does not exercise regularly and reports having 1–2 glasses of wine on the weekend. She lives with her husband and two teenage children and works in the kitchen at the children’s school.

History
Hyperlipidemia
Type 2 diabetes

Current Medications
Atorvastatin, 20 mg once daily
Metformin, 500 mg twice daily

Which of the following diagnostic tests would the nurse expect the health care provider to order for Hahn?
  1. a.
    Echocardiogram
  2. b.
    Cardiac catheterization
  3. c.
    Renal function panel
  4. d.
    Hepatic function panel

Answer

C. Renal function panel
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.

Case Study 18.5.3 §18.5 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Hahn Tran follows up with her health care provider one week later to get the results of her diagnostic studies. The health care provider diagnose her with hypertension stage 2 and starts her on enalapril, an ACE inhibitor. The nurse then teaches Hahn about this new drug.

Which instruction about enalapril will the nurse give Hahn?
  1. a.
    Take this medication with a meal.
  2. b.
    Do not take this medication if your heart rate is less than 60 beats/minute.
  3. c.
    Avoid salt substitutes that contain potassium while taking this medication.
  4. d.
    Avoid eating grapefruit while taking this medication.

Answer

C. Avoid salt substitutes that contain potassium while taking this medication.
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.

Case Study 18.5.4 §18.5 source ↗

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.

Hahn Tran follows up with her health care provider one week later to get the results of her diagnostic studies. The health care provider diagnose her with hypertension stage 2 and starts her on enalapril, an ACE inhibitor. The nurse then teaches Hahn about this new drug.

Which nonpharmacologic treatment should the nurse anticipate the health care provider will prescribe for the client?
  1. a.
    Increase salt intake.
  2. b.
    Stop smoking.
  3. c.
    Walk 30–40 minutes twice weekly.
  4. d.
    Take naproxen sodium for headaches.

Answer

B. Stop smoking.
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.

Case Study 18.7.5 §18.7 source ↗

Table 18.15 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Cardiovascular: No jugular vein distention or pedal edema; S1, S2 noted.

• Respiratory: Breath sounds clear on auscultation.
Blood pressure: 144/90 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'3"
Weight: 188 lb

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up from Case Study Parts A and B.

Hahn Tran is following up with the health care provider 3 months after her initial diagnosis of hypertension stage 2. She reports her headaches and dizziness have improved; however, she is now reporting chest pain when she walks 1–2 miles. The chest pain is relieved by resting on a park bench. Hahn states she experiences a burning in her chest that does not radiate to other areas. She denies nausea, diaphoresis, shortness of breath, or dizziness with chest pain.

The nurse performs a 12-lead ECG on Hahn, as ordered. The health care provider notes that there are no ischemic changes and diagnoses Hahn with stable angina. The health care provider prescribes verapamil 40 mg orally three times daily and nitroglycerin 0.4 mg sublingually for chest pain. The nurse is developing a teaching care plan for Hahn.

Which instruction about verapamil will the nurse include in the teaching plan?
  1. a.
    Limit your fluid intake when taking this medication.
  2. b.
    Do not take this medication on an empty stomach.
  3. c.
    Swelling of your feet is common when taking this medication.
  4. d.
    Increase your daily fiber intake when taking this medication.

Answer

D. Increase your daily fiber intake when taking this medication.
Constipation is an adverse effect of verapamil, so the nurse instructs Hahn to increase her daily fiber intake to help reduce this effect.

Case Study 18.7.6 §18.7 source ↗

Table 18.15 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Cardiovascular: No jugular vein distention or pedal edema; S1, S2 noted.

• Respiratory: Breath sounds clear on auscultation.
Blood pressure: 144/90 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 16 breaths/min
Oxygen saturation: 98% on room air
Height: 5'3"
Weight: 188 lb

Read the following clinical scenario to answer the questions that follow. This case study is a follow-up from Case Study Parts A and B.

Hahn Tran is following up with the health care provider 3 months after her initial diagnosis of hypertension stage 2. She reports her headaches and dizziness have improved; however, she is now reporting chest pain when she walks 1–2 miles. The chest pain is relieved by resting on a park bench. Hahn states she experiences a burning in her chest that does not radiate to other areas. She denies nausea, diaphoresis, shortness of breath, or dizziness with chest pain.

The nurse performs a 12-lead ECG on Hahn, as ordered. The health care provider notes that there are no ischemic changes and diagnoses Hahn with stable angina. The health care provider prescribes verapamil 40 mg orally three times daily and nitroglycerin 0.4 mg sublingually for chest pain. The nurse is developing a teaching care plan for Hahn.

The nurse teaches Hahn about a heart-healthy diet. Which statement by Hahn indicates a need for further teaching?
  1. a.
    “I can eat red meat every day.”
  2. b.
    “I need to reduce my salt intake.”
  3. c.
    “Apples and oranges are a good snack option.”
  4. d.
    “I can replace table salt with dried herbs.”

Answer

A. “I can eat red meat every day.”
In a heart-healthy diet, the client should reduce her intake of red meat. This statement indicates a need for further teaching.

18-1 §18.RQ source ↗

A client has a blood pressure of 148/96 mm Hg. According to the American Heart Association Guidelines, how should the nurse classify this blood pressure?
  1. a.
    Normal
  2. b.
    Elevated
  3. c.
    Hypertension stage 1
  4. d.
    Hypertension stage 2

Answer

D. Hypertension stage 2
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.

18-2 §18.RQ source ↗

A home health nurse is monitoring a client who has a history of hypertension and is taking benazepril. Which outcome indicates a therapeutic effect of the medication?
  1. a.
    Heart rate of 96 beats/minute
  2. b.
    Blood pressure of 126/76 mm Hg
  3. c.
    Potassium level of 5.1 mEq/dl
  4. d.
    Dry cough and fatigue

Answer

B. Blood pressure of 126/76 mm Hg
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.

18-3 §18.RQ source ↗

A nurse is reviewing the health history of a client with hypertension and coronary artery disease. The health care provider is considering a beta-adrenergic blocker, nadolol, for the client. Which condition in the client’s health history should the nurse report to the health care provider as a contraindication for nadolol?
  1. a.
    Asthma
  2. b.
    Hypertension
  3. c.
    Tachycardia
  4. d.
    Myocardial infarction

Answer

A. Asthma
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.

18-4 §18.RQ source ↗

The health care provider’s order is for metoprolol 0.1 g orally daily. The tablets are available in 50 mg. How many tablets should the nurse administer?
  1. a.
    1 tablet
  2. b.
    2 tablets
  3. c.
    4 tablets
  4. d.
    5 tablets

Answer

B. 2 tablets
0.1 g = 100 m g . 100 m g ÷ 50 m g = 2 t a b l e t s .

18-5 §18.RQ source ↗

A client with newly diagnosed stable angina is prescribed transdermal nitroglycerin. Which instruction should the nurse include in client teaching?
  1. a.
    Apply to the same area of the body every day.
  2. b.
    Apply a new patch at the onset of chest pain.
  3. c.
    Apply a new patch after showering while skin is still moist.
  4. d.
    Apply the patch for 12–14 hours and then remove for 10–12 hours.

Answer

D. Apply the patch for 12–14 hours and then remove for 10–12 hours.
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.

18-6 §18.RQ source ↗

A nurse is providing education to a client who has a new prescription for verapamil. The nurse should instruct the client to avoid which beverage when taking verapamil?
  1. a.
    Milk
  2. b.
    Coffee
  3. c.
    Tomato juice
  4. d.
    Grapefruit juice

Answer

D. Grapefruit juice
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.

18-7 §18.RQ source ↗

A nurse is teaching a client with newly diagnosed hypertension about a prescription for hydrochlorothiazide. Which instruction should the nurse include in the client teaching?
  1. a.
    Take this medication at bedtime.
  2. b.
    Monitor for leg cramps.
  3. c.
    Avoid citrus juices.
  4. d.
    Reduce your intake of potassium-rich foods.

Answer

B. Monitor for leg cramps.
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.

18-8 §18.RQ source ↗

The nurse is to administer carvedilol 6.25 mg orally twice daily. The tablets available contain 3.125 mg. How many tablets will the client receive per dose?
  1. a.
    1 tablet
  2. b.
    2 tablets
  3. c.
    3 tablets
  4. d.
    4 tablets

Answer

B. 2 tablets
6.25 m g ÷ 3.125 m g = 2 t a b l e t s p e r d o s e .

18-9 §18.RQ source ↗

A client is being prescribed losartan at discharge from the hospital by the health care provider. The discharge instructions by the nurse should include what information about how losartan acts?
  1. a.
    It inhibits beta 1 and beta 2.
  2. b.
    It inhibits angiotensin-converting enzyme.
  3. c.
    It prevents the release of angiotensin.
  4. d.
    It blocks angiotensin II from angiotensin I receptors.

Answer

D. It blocks angiotensin II from angiotensin I receptors.
Losartan is a selective and competitive angiotensin II receptor blocker (ARB) at the angiotensin I receptor.

18-10 §18.RQ source ↗

A nurse is preparing to administer carvedilol to a client with hypertension. Which assessment finding should the nurse report to the health care provider before administering the drug?
  1. a.
    Apical heart rate 56 beats/minute
  2. b.
    Blood pressure 114/74 mm Hg
  3. c.
    Temperature 98.6°F
  4. d.
    Respiratory rate 18 breaths/minute

Answer

A. Apical heart rate 56 beats/minute
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.

Loading chapter 19…

Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.