NSG 320 Exam 2 Cardiovascular Part 1 and Part 2
Questions With Complete Solutions
Hypertension (HTN)
high blood pressure = modifiable
CO
SV × HR
BP
CO x SVR = force exerted by the blood against the walls of the
blood vessel, maintains tissue perfusion
Primary Hypertension
A.K.A. Essential or Idiopathic HTN; without an identified
cause.
90-95% of all cases of HTN.
-consider known risk factors of HTN
Secondary Hypertension
Specific cause that can usually be identified and corrected -
underlying cause
-cirrhosis
-narrowing of aorta
-drug related
-endocrine problems
-neurologic
-pregnancy induced HTN
,-renal disease
-sleep apnea
Clinical Manifestations & Complications of HTN
•Silent Killer"
•The various symptoms of HTN can include:
•Dizziness
•Palpitations
•Angina
•Dyspnea
•Symptoms are due to its effects on blood vessels in organs and
tissues, OR the increased workload of the heart.
Diagnosis of HTN
BP measurement
History and Physical assessment, including an ophthalmic
examination
Urinalysis
Labs: Basic metabolic panel (BMP) with estimated glomerular
filtration rate (eGFR), blood urea nitrogen (BUN), creatinine,
complete blood count (CBC), lipid profile
12-Lead electrocardiogram (ECG)
Interprofessional Care of HTN
Goal
Achieving and maintaining goal BP
Reducing CV risk and target organ disease
Lifestyle Modifications
The American Heart Association's (AHA) "Life's Simple 7"
,Weight Loss
Nutrition and Diet
Sodium (Na) restriction
Moderate alcohol use
Physical Activity
Avoiding tobacco products
Other risk factors
HTN •Thiazide diuretics: Hydrochlorothiazide (HCTZ)
Inhibit NACl reabsoroption in distal convoluted tubule
-Increase Na/Cl
-initial decrease in ECF
-Sustained decrease in SVR
-Lower BP moderately in 2-4 weeks
Thiazide diuretics: Nursing Implications
Orthostatic hypotension, low K, alkalosis
Cardiotoxicity of digoxin from low K
Na restriction decreases risk of low K
NSAIDs decrease diuretics/antihypertensive effect and
potentially cause renal problems
Eat K- rich foods
•This drug is a diuretic that will increase the amount of water
excreted as urine. Decreasing the amount of fluid circulating in
your blood stream will work to decrease your blood pressure.
•Take in the morning to prevent nocturnal diuresis.
•Use sugarless gum or hard candy to help ease dry mouth that
may occur.
, HTN •Calcium channel blockers (CCB): Diltiazem extended
release (Cardizem LA)
Inhibit movement of Ca+ across cell membrane, resulting in
vasodilation
Cardioselective - decrease in HR, slow AV conduction
Calcium channel blockers (CCB): Nursing Implications
Caution: HF
Grapefruit juice interactions - increase serum concentrations and
toxicity
Use for SVT dysrhythmias
Avoid in cliences with 2nd/3rd deg AV block or left ventricular
systolic dysfunction
HTN •Angiotensin-converting enzyme (ACE) inhibitors:
Lisinopril (Zestril)
Inhibit ACE, decrease conversion of A-I to A-II
Inhibit A-II-mediated vasoconstriction
reduce vasoconstriction and sodium and water retention
Angiotensin-converting enzyme (ACE) inhibitors: Nursing
Implications
Aspirin and NSAIDs may decrease effectiveness
Do not use with K+ sparing - ok with reg. diuretics
Can increase serum Cre
Inhibit breakdown of bradykinin, which may cause a dry
hacking cough
Captopril PO for hypertensive crisis
HTN •Angiotensin II receptor blocker (ARB): Losartan (Cozaar)
Questions With Complete Solutions
Hypertension (HTN)
high blood pressure = modifiable
CO
SV × HR
BP
CO x SVR = force exerted by the blood against the walls of the
blood vessel, maintains tissue perfusion
Primary Hypertension
A.K.A. Essential or Idiopathic HTN; without an identified
cause.
90-95% of all cases of HTN.
-consider known risk factors of HTN
Secondary Hypertension
Specific cause that can usually be identified and corrected -
underlying cause
-cirrhosis
-narrowing of aorta
-drug related
-endocrine problems
-neurologic
-pregnancy induced HTN
,-renal disease
-sleep apnea
Clinical Manifestations & Complications of HTN
•Silent Killer"
•The various symptoms of HTN can include:
•Dizziness
•Palpitations
•Angina
•Dyspnea
•Symptoms are due to its effects on blood vessels in organs and
tissues, OR the increased workload of the heart.
Diagnosis of HTN
BP measurement
History and Physical assessment, including an ophthalmic
examination
Urinalysis
Labs: Basic metabolic panel (BMP) with estimated glomerular
filtration rate (eGFR), blood urea nitrogen (BUN), creatinine,
complete blood count (CBC), lipid profile
12-Lead electrocardiogram (ECG)
Interprofessional Care of HTN
Goal
Achieving and maintaining goal BP
Reducing CV risk and target organ disease
Lifestyle Modifications
The American Heart Association's (AHA) "Life's Simple 7"
,Weight Loss
Nutrition and Diet
Sodium (Na) restriction
Moderate alcohol use
Physical Activity
Avoiding tobacco products
Other risk factors
HTN •Thiazide diuretics: Hydrochlorothiazide (HCTZ)
Inhibit NACl reabsoroption in distal convoluted tubule
-Increase Na/Cl
-initial decrease in ECF
-Sustained decrease in SVR
-Lower BP moderately in 2-4 weeks
Thiazide diuretics: Nursing Implications
Orthostatic hypotension, low K, alkalosis
Cardiotoxicity of digoxin from low K
Na restriction decreases risk of low K
NSAIDs decrease diuretics/antihypertensive effect and
potentially cause renal problems
Eat K- rich foods
•This drug is a diuretic that will increase the amount of water
excreted as urine. Decreasing the amount of fluid circulating in
your blood stream will work to decrease your blood pressure.
•Take in the morning to prevent nocturnal diuresis.
•Use sugarless gum or hard candy to help ease dry mouth that
may occur.
, HTN •Calcium channel blockers (CCB): Diltiazem extended
release (Cardizem LA)
Inhibit movement of Ca+ across cell membrane, resulting in
vasodilation
Cardioselective - decrease in HR, slow AV conduction
Calcium channel blockers (CCB): Nursing Implications
Caution: HF
Grapefruit juice interactions - increase serum concentrations and
toxicity
Use for SVT dysrhythmias
Avoid in cliences with 2nd/3rd deg AV block or left ventricular
systolic dysfunction
HTN •Angiotensin-converting enzyme (ACE) inhibitors:
Lisinopril (Zestril)
Inhibit ACE, decrease conversion of A-I to A-II
Inhibit A-II-mediated vasoconstriction
reduce vasoconstriction and sodium and water retention
Angiotensin-converting enzyme (ACE) inhibitors: Nursing
Implications
Aspirin and NSAIDs may decrease effectiveness
Do not use with K+ sparing - ok with reg. diuretics
Can increase serum Cre
Inhibit breakdown of bradykinin, which may cause a dry
hacking cough
Captopril PO for hypertensive crisis
HTN •Angiotensin II receptor blocker (ARB): Losartan (Cozaar)
