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Chapter 22: Antihypertensive Drugs
Test Bank
MULTIPLE CHOICE
1. A patient has a new order for the adrenergic drug doxazosin (Cardura). When providing
education about this drug, the nurse will include which instructions?
a. “Weigh yourself daily, and report any weight loss to your prescriber.”
b. “Increase your potassium intake by eating more bananas and apricots.”
c. “The impaired taste associated with this medication usually goes away in 2 to 3
weeks.”
d. “Be sure to lie down after taking the first dose, because first-dose hypotension may
make you dizzy.”
ANS: D
A patient who is starting doxazosin should take the first dose while lying down because there
is a first-dose hypotensive effect with this medication. The other options are incorrect.
DIF: COGNITIVE LEVEL: Analyzing (Analysis)
REF: p. 362
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
2. A patient with severe liver disease is receiving the angiotensin converting enzyme (ACE)
inhibitor, captopril (Capoten). The nurse is aware that the advantage of this drug for this
patient is which characteristic?
a. Captopril rarely causes first-dose hypotensive effects.
b. Captopril has little effect on electrolyte levels.
c. Captopril is a prodrug and is metabolized by the liver before becoming active.
d. Captopril is not a prodrug and does not need to be metabolized by the liver before
becoming active.
ANS: D
A prodrug relies on a functioning liver to be converted to its active form. Captopril is not a
prodrug, and therefore it would be safer for the patient with liver dysfunction.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 354
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. During a follow-up visit, the health care provider examines the fundus of the patient’s eye.
Afterward, the patient asks the nurse, “Why is he looking at my eyes when I have high blood
pressure? It does not make sense to me!” What is the best response by the nurse?
a. “We need to monitor for drug toxicity.”
b. “We must watch for increased intraocular pressure.”
c. “The provider is assessing for visual changes that may occur with drug therapy.”
d. “The provider is making sure the treatment is effective over the long-term.”
ANS: D
The physician would examine the fundus of a patient’s eyes during antihypertensive therapy
because it is a more reliable indicator than blood pressure readings of the long-term
effectiveness of treatment.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 364
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
4. The nurse is preparing for a community education program on hypertension. Which of these
parameters determine the regulation of arterial blood pressure?
a. Cardiac output and systemic vascular resistance
b. Heart rate and peripheral resistance
c. Blood volume and renal blood flow
d. Myocardial contractility and arteriolar constriction
ANS: A
Blood pressure is determined by the product of cardiac output and systemic vascular
resistance. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 348
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. When counseling a male patient about the possible adverse effects of antihypertensive drugs,
the nurse will discuss which potential problem?
a. Impotence
b. Bradycardia
c. Increased libido
d. Weight gain
ANS: A
Sexual dysfunction is a common complication of antihypertensive medications and may be
manifested in men as decreased libido or impotence. The other options are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 366
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is reviewing drug therapy for hypertension. According to the JNC 7 guidelines,
antihypertensive drug therapy for a newly diagnosed stage 1 hypertensive African-American
patient would most likely include which drug or drug classes?
a. Vasodilators alone
b. ACE inhibitors alone
c. Calcium channel blockers with thiazide diuretics
d. Beta blockers with thiazide diuretics
ANS: C
According to the JNC 7 guidelines, calcium channel blockers and diuretics have been shown
to be more effective in African Americans than in white patients. Thiazide diuretics are also
recommended for newly diagnosed stage 1 hypertension.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 361
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is creating a plan of care for a patient with a new diagnosis of hypertension. Which
is a potential nursing diagnosis for the patient taking antihypertensive medications?
a. Diarrhea
b. Sexual dysfunction
c. Urge urinary incontinence
d. Impaired memory
ANS: B
Sexual dysfunction is a potential nursing diagnosis related to possible adverse effects of
antihypertensive drug therapy. The other nursing diagnoses are not appropriate.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 361
TOP: NURSING PROCESS: Nursing Diagnosis
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. A patient’s blood pressure elevates to 270/150 mm Hg, and a hypertensive emergency is
obvious. He is transferred to the intensive care unit and started on a sodium nitroprusside
(Nipride) drip to be titrated per his response. With this medication, the nurse knows that the
maximum dose of this drug should be infused for how long?
a. 10 minutes
b. 30 minutes
c. 1 hour
d. 24 hours
ANS: A
Sodium nitroprusside is a potent vasodilator and may lead to extreme decreases in the
patient’s blood pressure. For this reason, it is never infused at the maximum dose for more
than 10 minutes. If this drug does not control a patient’s blood pressure after 10 minutes, it
will most likely be ordered to be discontinued. The other times listed are incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 363
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. A patient with primary hypertension is prescribed drug therapy for the first time. The patient
asks how long drug therapy will be needed. Which answer by the nurse is the correct
response?
a. “This therapy will take about 3 months.”
b. “This therapy will take about a year.”
c. “This therapy will go on until your symptoms disappear.”
d. “Therapy for high blood pressure is usually lifelong.”
ANS: D
There is no cure for the disease, and treatment will be lifelong. The other answers are not
appropriate.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 361
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. A patient who has been taking antihypertensive drugs for a few months complains of having a
persistent dry cough. The nurse knows that this cough is an adverse effect of which class of
antihypertensive drugs?
a. Beta blockers
b. Angiotensin-converting enzyme (ACE) inhibitors
c. Angiotensin II receptor blockers (ARBs)
d. Calcium channel blockers
ANS: B
ACE inhibitors cause a characteristic dry, nonproductive cough that reverses when therapy is
stopped. The other drug classes do not cause this cough.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 355
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. A pregnant woman is experiencing hypertension. The nurse knows that which drug is
commonly used for a pregnant patient who is experiencing hypertension?
a. mannitol (Osmitrol)
b. enalapril (Vasotec)
c. hydrochlorothiazide (HydroDIURIL)
d. methyldopa (Aldomet)
ANS: D
Methyldopa is used in the treatment of hypertension during pregnancy. The other options are
incorrect.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 352
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
12. The nurse is reviewing the JNC 7 guidelines for treatment of hypertension. Which blood
pressure would be classified as “prehypertension” according to the JNC 7 guidelines?
a. 118/76 mm Hg
b. 130/88 mm Hg
c. 150/90 mm Hg
d. 160/104 mm Hg
ANS: B
Prehypertension is defined as having a systolic blood pressure between 120 and 139 mm Hg
and a diastolic pressure between 80 and 89 mm Hg. The other parameters listed are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 360
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
13. A patient with type 2 diabetes mellitus has been found to have trace proteinuria. The
prescriber writes an order for an angiotensin-converting enzyme (ACE) inhibitor. What is the
main reason for prescribing this class of drug for this patient?
a. Cardioprotective effects
b. Renal protective effects
c. Reduces blood pressure
d. Promotes fluid output
ANS: B
ACE inhibitors have been shown to have a protective effect on the kidneys because they
reduce glomerular filtration pressure. This is one reason that they are among the
cardiovascular drugs of choice for diabetic patients. The other drugs do not have this effect.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: pp. 354-355
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. The nurse is reviewing the orders for a patient and notes a new order for an
angiotensin-converting enzyme (ACE) inhibitor. The nurse checks the current medication
orders, knowing that this drug class may have a serious interaction with what other drug
class?
a. Calcium channel blockers
b. Diuretics
c. Nonsteroidal antiinflammatory drugs
d. Nitrates
ANS: C
Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen can reduce the
antihypertensive effect of ACE inhibitors. In addition, the use of NSAIDs and ACE inhibitors
may also predispose patients to the development of acute renal failure.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 355
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
15. An elderly patient will be taking a vasodilator for hypertension. Which adverse effect is of
most concern for the older adult patient taking this class of drug?
a. Dry mouth
b. Restlessness
c. Constipation
d. Hypotension
ANS: D
The elderly are more sensitive to the blood pressure–lowering effects of vasodilators, and
consequently experience more problems with hypotension, dizziness, and syncope. The other
options are incorrect.
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. 361
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
1. When teaching a patient about antihypertensive drug therapy, which statements by the nurse
are correct? (Select all that apply.)
a. “You need to have your blood pressure checked once a week and keep track of the
readings.”
b. “If you notice that the symptoms have gone away, you should be able to stop
taking the drug.”
c. “An exercise program may be helpful in treating hypertension, but let’s check with
your doctor first.”
d. “If you experience severe side effects, stop the medicine and let us know at your
next office visit.”
e. “Most over-the-counter decongestants are compatible with antihypertensive
f.
drugs.”
“Please continue taking the medication, even if you are feeling better.”
ANS: A, C, F
Keeping a record of weekly blood pressure checks helps to monitor the effectiveness of the
therapy. Remind the patient not to stop taking the medication just because he or she is feeling
better. Abruptly stopping the medication may lead to rebound hypertension. Therapy is often
life-long, even though symptoms may improve. Many over-the-counter drugs, especially
decongestants, have serious interactions with antihypertensive drugs. The patient needs to
consult his or her prescriber before taking any other medication.
DIF: COGNITIVE LEVEL: Analyzing (Analysis)
REF: pp. 365-366
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
OTHER
1. A patient is to receive enalapril (Vasotec) 5 mg IV every 6 hours. Each dose is given over 5
minutes. The medication is available in an injectable form, 1.25 mg/mL. How many milliliters
of medication will the nurse draw up for each dose?
ANS:
4 mL
1.25 mg : 1 mL :: 5 mg : x mL
(1.25  x) = (1  5); 1.25x = 5; x = 4
DIF: COGNITIVE LEVEL: Applying (Application)
REF: p. N/A
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies