Maryville NURS 615- Exam V with Written Questions and Expert Solutions

Maryville NURS 615- Exam V with Written Questions and Expert Solutions What assessments should be made before prescribing any antihypertensive agent? ANSWER BP, RF, and head to toe assessment. Assess diet, sodium intake, electrolytes, and potassium levels. Prior to prescribing any antihypertensives, creatinine and BUN levels should be evaluated. Confirmation of elevated BP at 3 different times. Children over 3 years old should be assessed at least once at every visit-preferred method for children is by auscultation, the correct measurement requires using a cuff that is appropriate to the child's upper arm. 12 lead EKG. UA, albumin, albumin/creatinine ratio. Diabetics or those with renal disease should have the albumin/creatinine ratio annually. The presence of albuminuria, micro albuminuria even in the setting of normal GFR is associated with increased cardiovascular risk. Blood sugar, hct, serum calcium, and lipid profile. Why are ACE inhibitors the drug of choice in diabetic patients with hypertension? ANSWER ACE-Is will improve insulin sensitivity, as well as reduce the effects of DM on the kidneys. Protect the kidneys, watch for renal function, any creatinine >2.5 requires dose reduction. Prevents diabetic nephropathy or slow its progression. Reduce albuminuria and BP. ACEIs and ARBs should be used to treat the HTN. Renal protection, reduces the conversion of AT II and improve the insulin sensitivity. What is the drug of choice to improve symptoms for patients taking propranolol? ANSWER Ipratropium What is the most common adverse effect of an ACE inhibitor? ANSWER Dry, hacking cough in some patients. Can switch to an angiotensin blocker which won't cause cough. Reduce dose with either of these if Cr >2.5. Most are associated with hypotension, dizziness, HA, fatigue, orthostatic hypotension, tachyphylaxis.