Nitroprusside infusions are kept as short as possible because the drug breaks down to release cyanide, a poison that can be fatal.
Missing Word
cyanide
Cyanide is a toxic byproduct of nitroprusside metabolism. A boxed warning states that cyanide builds up with higher doses and longer infusions, so the infusion is limited and the client is watched closely.
Category: Nitrates
Question 2
Untreated hypertension can damage the kidneys and progress to end-stage renal disease, in which dialysis filters the blood in place of the kidneys.
Missing Word
dialysis
Dialysis replaces kidney filtration when the kidneys fail. Long-standing high blood pressure damages renal vessels, which is one reason early treatment matters.
Category: Hypertension Basics
Question 3
An echocardiogram, an ultrasound of the heart, is not routinely required in hypertension but can show changes such as a thickened heart muscle.
Missing Word
echocardiogram
An echocardiogram uses ultrasound to image the heart's chambers, valves and pumping. In long-standing hypertension it may reveal cardiac hypertrophy.
Category: Hypertension Basics
Question 4
Clients with hypertension are taught to avoid real licorice, whose glycyrrhizin causes sodium retention and can raise blood pressure.
Missing Word
licorice
Licorice contains glycyrrhizin, which produces an aldosterone-like effect: the kidneys retain sodium and water and lose potassium, raising blood pressure. It is one of the substances clients taking beta blockers and other antihypertensives are told to avoid.
Category: Hypertension Basics
Question 5
Clients taking metoprolol are taught to limit caffeine, the stimulant in coffee, tea and energy drinks, which can work against the drug's slowing of the heart.
Missing Word
caffeine
Caffeine stimulates the heart and can raise heart rate and blood pressure, opposing the effects of a beta blocker. Clients are also taught to check with the provider before taking stimulant herbal supplements, which can interfere with beta blocker therapy.
Category: Beta Blockers
Question 6
Angina is chest discomfort from reduced blood flow to the heart that may also be felt in the jaw, neck, shoulders or arms.
Missing Word
Angina
Angina, or angina pectoris, results from an imbalance between the heart's oxygen supply and demand. Typical stable episodes ease with rest or sublingual nitrates.
Category: Angina
Question 7
Clients taking an ACE inhibitor are taught to avoid salt substitutes because most replace sodium with potassium.
Missing Word
potassium
Potassium chloride is the main ingredient in most salt substitutes. ACE inhibitors reduce aldosterone and cause potassium retention, so adding a potassium-based salt substitute or many high-potassium foods raises the risk of hyperkalemia.
Category: ACE Inhibitors and ARBs
Question 8
Valsartan is contraindicated with aliskiren, a direct inhibitor of the enzyme that starts the angiotensin cascade, in clients with diabetes.
Missing Word
aliskiren
Aliskiren is a direct renin inhibitor. Combining it with an ARB or ACE inhibitor in clients with diabetes raises the risk of kidney injury, hyperkalemia and hypotension.
Category: ACE Inhibitors and ARBs
Question 9
Beta blockers are used not only for heart disease but also, as eye drops, to treat glaucoma, a disease of raised pressure inside the eye.
Missing Word
glaucoma
Glaucoma is raised pressure inside the eye. Beta blocker eye drops reduce the production of aqueous humor, which lowers that pressure.
Category: Beta Blockers
Question 10
Amlodipine belongs to the dihydropyridine group of calcium channel blockers, which act mainly on peripheral arteries.
Missing Word
dihydropyridine
Dihydropyridines such as amlodipine and nifedipine are strong peripheral vasodilators used for hypertension and angina. Unlike diltiazem and verapamil, they are not used to treat dysrhythmias.
Category: Calcium Channel Blockers
Question 11
Taking a diuretic in the morning helps prevent nocturia, the need to get up and urinate during the night.
Missing Word
nocturia
Nocturia is nighttime urination. Morning dosing lets most of the diuresis happen during the day, so sleep is not disrupted.
Category: Diuretics
Question 12
Clients taking a thiazide should eat foods such as bananas, avocados and spinach to help prevent hypokalemia.
Missing Word
hypokalemia
Hypokalemia is a low serum potassium level. Thiazides cause potassium loss in the urine, so clients are taught to eat potassium-rich foods and report weakness or leg cramps.
Category: Diuretics
Question 13
Thiazide diuretics can raise uric acid levels, so they are used cautiously in clients with gout.
Missing Word
gout
Gout is a painful arthritis caused by uric acid crystals in the joints. Because thiazides reduce uric acid excretion, they can trigger attacks in susceptible clients.
Category: Diuretics
Question 14
Calcium channel blockers, especially verapamil, commonly cause constipation, so clients are taught to increase fluid and fiber intake.
Missing Word
constipation
Constipation is a common adverse effect of calcium channel blockers because blocking calcium entry relaxes the smooth muscle of the gut as well as the vessels. Verapamil is the drug in the class most associated with it.
Category: Calcium Channel Blockers
Question 15
Nitrates are contraindicated in a client with hypertrophic cardiomyopathy.
Missing Word
cardiomyopathy
Cardiomyopathy is a disease of the heart muscle. In the hypertrophic form, nitrate vasodilation can worsen obstruction of blood flow out of the heart and cause severe hypotension.
Category: Nitrates