High blood pressure caused by an identifiable condition, such as kidney disease or an adrenal tumor, is classified as which type?
Secondary hypertension
✓
Primary hypertension
White-coat hypertension
Isolated systolic hypertension
Correct Answer
Secondary hypertension
Secondary hypertension results from an underlying renal, endocrine or nervous system condition, and it may be cured if that condition is treated successfully. Primary hypertension has no identifiable cause. White-coat hypertension is a reading raised only in a clinical setting. Isolated systolic hypertension describes a raised systolic value with a normal diastolic value, not a cause.
Category: Hypertension Basics
Question 2
Which dietary change should the nurse teach a client with newly diagnosed hypertension?
Increase red meat at most meals
Limit sodium and eat more vegetables
✓
Add salt only at the table
Avoid all dairy products
Correct Answer
Limit sodium and eat more vegetables
A low-sodium diet rich in vegetables, fruit, whole grains and low-fat dairy helps lower blood pressure and is a core lifestyle measure alongside drug therapy. Increasing red meat at most meals runs against the advice to limit red meat and sweets. Adding salt only at the table still raises sodium intake. Avoiding all dairy products is unnecessary, since low-fat dairy is part of the recommended pattern.
Category: Hypertension Basics
Question 3
Which beta blocker, which also blocks alpha-1 receptors, is given IV to lower blood pressure quickly in a hypertensive emergency?
Atenolol
Nadolol
Labetalol
✓
Bisoprolol
Correct Answer
Labetalol
Labetalol blocks beta and alpha-1 receptors, so it lowers heart rate and dilates vessels, and its IV form is used for rapid blood pressure control in hypertensive emergencies. Atenolol is a cardioselective beta blocker with no alpha-blocking action. Nadolol is a nonselective beta blocker with no alpha-blocking action. Bisoprolol is a cardioselective beta blocker with no alpha-blocking action.
Category: Beta Blockers
Question 4
A client has episodes of chest pain at rest caused by coronary artery spasm rather than by plaque narrowing. Which type of chest pain is this?
Stable angina
Unstable angina
Microvascular angina
Variant angina
✓
Correct Answer
Variant angina
Variant, or Prinzmetal, angina is caused by coronary artery spasm and almost always occurs at rest; triggers include cocaine, cannabis, tobacco, some decongestants and stress. Stable angina follows a predictable pattern, usually with exertion. Unstable angina is unpredictable, often occurs at rest and signals a medical emergency from coronary artery disease. Microvascular angina comes from disease of the smallest coronary vessels.
Category: Angina
Question 5
A client who started enalapril last month develops sudden swelling of the lips and tongue. What should the nurse do?
Hold the drug and get emergency help
✓
Give the next dose with food
Apply ice and continue the drug
Start a low-sodium diet
Correct Answer
Hold the drug and get emergency help
Swelling of the lips and tongue suggests angioedema, a rare but life-threatening ACE inhibitor reaction that can block the airway, so the drug is held and emergency care is obtained; the client should not receive ACE inhibitors again. Giving the next dose with food continues the cause. Applying ice and continuing the drug ignores the airway risk. Starting a low-sodium diet does nothing for angioedema.
Category: ACE Inhibitors and ARBs
Question 6
Shortly after the first dose of captopril, a client feels lightheaded when standing up. Which adverse effect does this reflect?
Angioedema
First-dose hypotension
✓
Hyperkalemia
Hypoglycemia
Correct Answer
First-dose hypotension
ACE inhibitors can cause a sharp drop in blood pressure with the first dose, so the nurse monitors blood pressure at the start of therapy and teaches the client to rise slowly. Angioedema is swelling of the face, lips or tongue. Hyperkalemia is a high potassium level that causes weakness or dysrhythmias rather than postural lightheadedness. Hypoglycemia is low blood glucose and is not the expected first-dose effect.
Category: ACE Inhibitors and ARBs
Question 7
Shortly after taking isosorbide dinitrate, a client feels lightheaded and the blood pressure has dropped. What should the nurse teach the client to do?
Take a second dose right away
Walk briskly to raise the pressure
Lie down with the legs raised
✓
Drink a cup of strong coffee
Correct Answer
Lie down with the legs raised
Nitrate vasodilation can lower blood pressure, and lying down with the legs raised helps return blood to the heart and brain; the client then notifies the provider. Taking a second dose right away would lower the pressure further. Walking briskly risks a fall from fainting. Drinking a cup of strong coffee does not treat nitrate-induced hypotension.
Category: Nitrates
Question 8
A client whose hypertension was controlled on valsartan begins taking ibuprofen daily for back pain, and the readings start to climb. Which explanation fits?
NSAIDs raise valsartan to toxic levels
Ibuprofen makes the kidneys excrete potassium
Valsartan stops working after a few weeks
NSAIDs can blunt the drug's antihypertensive effect
✓
Correct Answer
NSAIDs can blunt the drug's antihypertensive effect
NSAIDs such as ibuprofen cause sodium and water retention and can blunt the blood pressure-lowering effect of ARBs and ACE inhibitors, so the nurse reviews over-the-counter drug use when control slips. NSAIDs raising valsartan to toxic levels is not the mechanism. Ibuprofen making the kidneys excrete potassium is the wrong direction, since NSAIDs with ARBs tend to raise potassium. Valsartan stopping working after a few weeks is not a recognized effect.
Category: ACE Inhibitors and ARBs
Question 9
A client with heart failure is starting metoprolol for hypertension. Which finding should the client report as a possible sign of worsening heart failure?
Weight gain with ankle swelling
✓
A dry, hacking cough
Ringing in the ears
A metallic taste
Correct Answer
Weight gain with ankle swelling
Beta blockers reduce contractility, so starting them too fast can worsen heart failure, shown by fatigue, weight gain and peripheral edema; clients report these promptly. A dry, hacking cough is typical of ACE inhibitors. Ringing in the ears is not a heart failure sign. A metallic taste is not a heart failure sign.
Category: Beta Blockers
Question 10
Which common beta blocker adverse effect is a reason for caution in a client with Raynaud phenomenon?
Increased urination
Cold hands and feet
✓
Swollen gums
A persistent dry cough
Correct Answer
Cold hands and feet
Beta blockers commonly cause cold extremities by reducing peripheral blood flow, which can worsen the vasospasm of Raynaud phenomenon. Increased urination is linked to diuretics. Swollen gums are not a beta blocker effect. A persistent dry cough is linked to ACE inhibitors.
Category: Beta Blockers
Question 11
A client with COPD who uses albuterol is prescribed a beta blocker. Which interaction should the nurse recognize?
The beta blocker may raise serum potassium
The beta blocker may cause a dry cough
The beta blocker may weaken the effect of albuterol
✓
The beta blocker may raise blood calcium
Correct Answer
The beta blocker may weaken the effect of albuterol
Albuterol works by stimulating beta-2 receptors, and beta blockers can reduce its bronchodilating effect, so the nurse checks for short-acting beta agonist use and lung disease before giving a beta blocker. Raising serum potassium is linked to ACE inhibitors, ARBs and potassium-sparing diuretics. A dry cough is linked to ACE inhibitors. Raising blood calcium is not a beta blocker effect.
Category: Beta Blockers
Question 12
Which adverse effect should the nurse teach a client starting amlodipine to watch for and report?
A dry, nonproductive cough
Hearing loss
Excess hair growth
Swelling of the feet and ankles
✓
Correct Answer
Swelling of the feet and ankles
Peripheral edema is a well-known adverse effect of amlodipine and other dihydropyridines, caused by dilation of small arteries; other effects include headache, flushing, dizziness and palpitations. A dry, nonproductive cough is typical of ACE inhibitors. Hearing loss is not linked to amlodipine. Excess hair growth is linked to minoxidil.
Category: Calcium Channel Blockers
Question 13
Immediate-release nifedipine has been associated with which serious risk?
Myocardial infarction and stroke
✓
Liver failure
Agranulocytosis
Hearing loss
Correct Answer
Myocardial infarction and stroke
Immediate-release nifedipine can drop blood pressure rapidly and has been linked to a higher risk of myocardial infarction, stroke and dysrhythmias. Liver failure is not the recognized risk of this product. Agranulocytosis is linked to drugs such as procainamide. Hearing loss is not a recognized risk of nifedipine.
Category: Calcium Channel Blockers
Question 14
A nondihydropyridine such as diltiazem is contraindicated in which condition unless the client has a functioning pacemaker?
Stable angina
Sick sinus syndrome
✓
Atrial fibrillation
Hypertension
Correct Answer
Sick sinus syndrome
Nondihydropyridines slow the SA and AV nodes, so they can cause dangerous bradycardia or pauses in sick sinus syndrome unless a pacemaker protects the rhythm. Stable angina is an indication for calcium channel blockers. Atrial fibrillation is an indication for rate control with diltiazem. Hypertension is an indication for calcium channel blockers.
Category: Calcium Channel Blockers
Question 15
A client with type 2 diabetes is starting hydrochlorothiazide. What should the nurse include in teaching?
Expect blood glucose to drop sharply
Take the drug at bedtime
Check blood glucose closely, since it may rise
✓
Stop the drug if urine output increases
Correct Answer
Check blood glucose closely, since it may rise
Thiazide diuretics can cause hyperglycemia, so clients with diabetes monitor their blood glucose closely. Expecting blood glucose to drop sharply is the wrong direction. Taking the drug at bedtime causes nighttime urination; morning dosing is taught. Stopping the drug if urine output increases is wrong, since more urine is the expected effect.
Category: Diuretics
Question 16
Which drug is a thiazide-like diuretic?
Spironolactone
Amiloride
Triamterene
Chlorthalidone
✓
Correct Answer
Chlorthalidone
Chlorthalidone is a thiazide-like diuretic that, like hydrochlorothiazide, inhibits sodium and chloride reabsorption in the distal tubule and causes potassium loss. Spironolactone is a potassium-sparing diuretic that blocks aldosterone. Amiloride is a potassium-sparing diuretic. Triamterene is a potassium-sparing diuretic.
Category: Diuretics
Question 17
Hydrochlorothiazide is contraindicated in which condition?
Anuria
✓
Peripheral edema
Mild hypertension
Heart failure
Correct Answer
Anuria
A diuretic cannot work when the kidneys produce no urine, so anuria is a contraindication to hydrochlorothiazide. Peripheral edema is an indication for diuretics. Mild hypertension is an indication for thiazides. Heart failure is a condition in which diuretics are used to remove excess fluid.
Category: Diuretics
Question 18
A client starting isosorbide mononitrate reports a throbbing headache. What should the nurse teach?
Stop the drug and do not take it again
Use acetaminophen as directed; headache is common
✓
Take an extra dose to build tolerance
Avoid all fluids until the headache resolves
Correct Answer
Use acetaminophen as directed; headache is common
Headache is a common nitrate effect from dilation of blood vessels in the head, and acetaminophen can help. Stopping the drug and not taking it again is not the response to an expected effect and can leave angina untreated. Taking an extra dose to build tolerance worsens hypotension. Avoiding all fluids until the headache resolves can worsen dizziness and hypotension.
Category: Nitrates
Question 19
A client who wears a nitroglycerin patch develops chest pain while walking. What should the nurse teach?
Apply a second patch over the first one
Remove the patch and wait for the pain to pass
Use sublingual nitroglycerin; the patch is not for acute pain
✓
Move the patch to a spot closer to the heart
Correct Answer
Use sublingual nitroglycerin; the patch is not for acute pain
A transdermal patch is long-acting maintenance therapy and is not used for acute chest pain; a sublingual dose acts rapidly. Applying a second patch over the first one does not relieve acute pain and risks hypotension. Removing the patch and waiting delays treatment of ischemia. Moving the patch to a spot closer to the heart does not change how fast it works.
Category: Nitrates
Question 20
Nitrates are contraindicated in which condition because the heart depends on adequate preload?
Stable angina
Hypertension
Heart failure
Right ventricular infarction
✓
Correct Answer
Right ventricular infarction
A client with a right ventricular infarction needs preload to maintain cardiac output, and nitrate venodilation can cause severe hypotension, so a history of right ventricular infarction is a contraindication. Stable angina is a main indication for nitrates. Hypertension is not a contraindication to nitrates, and IV nitroglycerin is used to lower blood pressure in some acute settings. Heart failure is a listed indication for nitrates.
Category: Nitrates