Chapter 22: Drugs Used to Treat Hypertension Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

1. A patient who has just begun taking an angiotensin converting enzyme (ACE) inhibitor calls the nurse and reports feeling very dizzy when standing up and asks if the medication should be discontinued. What is the nurse’s best response? a. “Stop taking the medication immediately.” b. “Rise to a sitting or standing position slowly; your symptoms will resolve.” c. “I will schedule you to visit the health care provider today.” d. “Cut the pill in half and take a reduced dosage.” ANS: B Dizziness is a common initial adverse effect of this medication, which is usually transient. The patient should be instructed to rise from a lying position slowly to avoid orthostatic hypotension and avoid falling. Medications should not be stopped immediately unless a serious adverse effect occurs. Because this is a common occurrence with ACE inhibitors, there is no need for a visit to the health care provider. A change in dosage will not alter the effect and should not be made without the advice of the primary care provider. DIF: Cognitive Level: Application REF: Page 348 OBJ: 2 TOP: Nursing Process Step: Implementation MSC: NCLEX Client Needs Category: Physiological Integrity NOT: CONCEPT(S): Clinical Judgment; Patient Education; Safety 2. Which nursing assessment confirms that the angiotensin II receptor blocker (ARB) that a patient is taking is effective? a. Weight loss of more than 2 pounds/week b. LDL cholesterol levels have decreased. c. Urinary output is increased. d. Blood pressure has decreased. ANS: D The primary therapeutic outcome expected from angiotensin II receptor antagonists is reduction of blood pressure to within a normal range. Angiotensin II receptor antagonists bind angiotensin II receptor sites in the vascular smooth muscle, brain, heart, kidneys, and adrenal gland. The blood pressure-elevating (vasoconstricting) and sodium-retaining effects of angiotensin II are thus blocked. Weight loss, although advisable for treatment of hypertension, is not affected by ARBs. ARBs do not affect cholesterol levels. Urine output is not affected by ARBs. DIF: Cognitive Level: Application REF: Page 349 | Page 350 OBJ: 2 | 5 T