Chapter 47: Drugs for Hypertension
Test Bank
MULTIPLE CHOICE
1. A patient has had blood pressures of 150/95 mm Hg and 148/90 mm Hg on two separate
office visits. The patient reports a blood pressure of 145/92 mm Hg taken in an ambulatory
setting. The patient’s diagnostic tests are all normal. The nurse will expect this patient’s
provider to order:
a. a beta blocker.
b. a loop diuretic and spironolactone.
c. a thiazide diuretic.
d. counseling on lifestyle changes.
ANS: C
This patient has primary, or essential, hypertension as evidenced by systolic pressure greater
than 140 and diastolic pressure greater than 90, along with normal tests ruling out another
primary cause. Thiazide diuretics are first-line drugs for hypertension. Beta blockers are
effective but are most often used to counter reflex tachycardia associated with reduced blood
pressure caused by therapeutic agents. Loop diuretics cause greater diuresis than is usually
needed and so are not first-line drugs. This patient should be counseled on lifestyle changes as
an adjunct to drug therapy but should also begin drug therapy because hypertension already
exists.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 499-500 | p. 505
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A patient with diabetes develops hypertension. The nurse will anticipate administering which
type of medication to treat hypertension in this patient?
a. ACE inhibitors
b. Beta blockers
c. Direct-acting vasodilators
d. Thiazide diuretics
ANS: A
ACE inhibitors slow the progression of kidney injury in diabetic patients with renal damage.
Beta blockers can mask signs of hypoglycemia and must be used with caution in diabetics.
Direct-acting vasodilators are third-line drugs for chronic hypertension. Thiazide diuretics
promote hyperglycemia.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 507-508 | pp. 510-511
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A patient has three separate blood pressure (BP) readings of 120/100 mm Hg, 138/92 mm Hg,
and 126/96 mm Hg. Which category describes this patient’s BP?
a. Hypertension
b. Isolated systolic hypertension
c. Normal
d. Prehypertension
ANS: A
Hypertension is defined as systolic BP over 140 mm Hg or diastolic BP over 90 mm Hg.
When systolic and diastolic BP fall into different categories, classification is based on the
higher category. This patient has a hypertensive diastolic BP. Isolated systolic hypertension
occurs if the systolic BP is greater than 140 mm Hg with a diastolic BP less than 90 mm Hg.
Because this patient has an elevated diastolic BP, it is not considered normal. Prehypertension
occurs with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 499-500
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
4. A nurse checks a patient’s vital signs in the hospital and notes a blood pressure of 146/98 mm
Hg. What will the nurse do?
a. Instruct the patient to consume a low-sodium diet.
b. Prepare the patient for an electrocardiogram and blood tests.
c. Recheck the patient’s blood pressure in the other arm.
d. Request an order for a thiazide diuretic.
ANS: C
Diagnosis of hypertension should be based on several blood pressure readings, not just one.
High readings should be confirmed in the contralateral arm. Low-sodium diets are indicated
for patients with confirmed hypertension. An electrocardiogram and blood tests are indicated
for patients with confirmed hypertension to rule out primary causes. Thiazide diuretics are
first-line drugs for confirmed hypertension.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 500
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A patient who does not consume alcohol or nicotine products reports a strong family history
of hypertension and cardiovascular disease. The patient has a blood pressure of 126/82 and a
normal weight and body mass index for height and age. The nurse will expect to teach this
patient about:
a. ACE inhibitors and calcium channel blocker medications.
b. the DASH diet, sodium restriction, and exercise.
c. increased calcium and potassium supplements.
d. thiazide diuretics and lifestyle changes.
ANS: B
This patient has prehypertension without other risk factors. Lifestyle changes are indicated at
this point. If blood pressure rises to hypertension levels, other measures, including drug
therapy, will be initiated. Calcium and potassium supplements are not indicated.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 501-503 | p. 507
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6. A patient with hypertension with a blood pressure of 168/110 mm Hg begins taking
hydrochlorothiazide and verapamil. The patient returns to the clinic after 2 weeks of drug
therapy, and the nurse notes a blood pressure of 140/85 mm Hg and a heart rate of 98 beats
per minute. What will the nurse do?
a. Notify the provider and ask about adding a beta blocker medication.
b. Reassure the patient that the medications are working.
c. Remind the patient to move slowly from sitting to standing.
d. Request an order for an electrocardiogram.
ANS: A
Beta blockers are often added to drug regimens to treat reflex tachycardia, which is a common
side effect of lowering blood pressure, caused by the baroreceptor reflex. The patient’s blood
pressure is responding to the medications, but the tachycardia warrants treatment. Reminding
the patient to move slowly from sitting to standing is appropriate with any blood pressure
medication, but this patient has reflex tachycardia, which must be treated. An
electrocardiogram is not indicated.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 502-503
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
7. A patient has been taking chlorthalidone to treat hypertension. The patient’s prescriber has
just ordered the addition of spironolactone to the patient’s drug regimen. Which statement by
the patient indicates a need for further teaching?
a. “I should continue following the DASH diet when adding this drug.”
b. “I should not take an ACE inhibitor when adding this drug.”
c. “I will need to take potassium supplements when adding this drug.”
d. “I will not experience a significant increase in diuresis when adding this drug.”
ANS: C
Spironolactone is given in addition to thiazide diuretics to balance potassium loss caused by
the thiazide diuretic. Patients should be advised against taking potassium supplements with
spironolactone, because hyperkalemia can result. The DASH diet may be continued. ACE
inhibitors are contraindicated because they promote hyperkalemia. Spironolactone does not
significantly increase diuresis.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 505 | p. 507
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. A nurse is discussing how beta blockers work to decrease blood pressure with a nursing
student. Which statement by the student indicates a need for further teaching?
a. “Beta blockers block the actions of angiotensin II.”
b. “Beta blockers decrease heart rate and contractility.”
c. “Beta blockers decrease peripheral vascular resistance.”
d. “Beta blockers decrease the release of renin.”
ANS: A
Beta blockers reduce the release of renin by blockade of beta1 receptors on juxtaglomerular
cells in the kidney, which reduces angiotensin II-mediated vasoconstriction, but do not block
the actions of angiotensin II directly. Beta blockers decrease heart rate and cardiac
contractility, decrease peripheral vascular resistance, and decrease the release of renin.
PTS: 1
DIF: Cognitive Level: Analysis
REF: p. 507
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
9. A patient with hypertension will begin taking an alpha1 blocker. What will the nurse teach this
patient?
a. A persistent cough is a known side effect of this drug.
b. Eat foods rich in potassium while taking this drug.
c. Move slowly from sitting to standing when taking this drug.
d. Report shortness of breath while taking this drug.
ANS: C
The most disturbing side effect of alpha blockers is orthostatic hypotension. Patients taking
these drugs should be cautioned to stand up slowly to avoid lightheadedness or falls. A
persistent cough is a common side effect of ACE inhibitors. It is not necessary to increase
dietary potassium intake when taking this drug. Shortness of breath may occur in individuals
with asthma who are taking beta blockers.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 507
TOP: Nursing Process: Teaching
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
10. A patient is taking clonidine for hypertension and reports having dry mouth and drowsiness.
What will the nurse tell the patient?
a. Beta blockers can reverse these side effects.
b. Discontinue the medication immediately and notify the provider.
c. Drink extra fluids and avoid driving when drowsy.
d. Notify the provider if symptoms persist after several weeks.
ANS: C
Clonidine can cause dry mouth and sedation; patients should be warned to drink extra fluids
and avoid driving. Beta blockers do not reverse these drug side effects. Discontinuing
clonidine abruptly can cause severe rebound hypertension. These are common side effects that
do not abate over time.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 507
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
11. A patient takes an ACE inhibitor to treat hypertension and tells the nurse that she wants to
become pregnant. She asks whether she should continue taking the medication while she is
pregnant. What will the nurse tell her?
a. Controlling her blood pressure will decrease her risk of preeclampsia.
b. Ask the provider about changing to an ARB during pregnancy.
c. Continue taking the ACE inhibitor during her pregnancy.
d. Discuss using methyldopa instead while she is pregnant.
ANS: D
Methyldopa has limited effects on uteroplacental and fetal hemodynamics and does not
adversely affect the fetus or neonate. Controlling blood pressure does not lower the risk of
preeclampsia. ACE inhibitors and ARBs are specifically contraindicated during pregnancy.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 513-514
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
12. A hospitalized patient has a blood pressure of 145/96 mm Hg. The nurse caring for this patient
notes that the blood pressure the day before was 132/98 mm Hg. The patient reports
ambulatory blood pressure readings of 136/98 and 138/92 mm Hg. The patient has a history of
a previous myocardial infarction and has adopted a lifestyle that includes use of the DASH
diet and regular exercise. What will the nurse do?
a. Notify the provider and discuss ordering a beta blocker for this patient.
b. Notify the provider and suggest a thiazide diuretic as initial therapy.
c. Order a diet low in sodium and high in potassium for this patient.
d. Recheck the patient’s blood pressure in 4 hours to verify the result.
ANS: A
Initial drug selection is determined by the presence or absence of a compelling indication or
comorbid condition. This patient has a history of MI; beta blockers are indicated for patients
with preexisting heart disease. Thiazide diuretics are first-line drugs of choice in patients
without compelling indications. The patient is already consuming a DASH diet; closer
monitoring of sodium or potassium will not help lower blood pressure. The patient has a
record of hypertension, so it is unnecessary to recheck the blood pressure to verify the
condition.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 509
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
13. Which two-drug regimen would be appropriate for a patient with hypertension who does not
have other compelling conditions?
a. Hydrochlorothiazide and nadolol
b. Hydralazine and minoxidil
c. Spironolactone and amiloride
d. Trichlormethiazide and hydrochlorothiazide
ANS: A
When two or more drugs are used to treat hypertension, each drug should come from a
different class. Hydrochlorothiazide is a diuretic and nadolol is a beta blocker, so this choice
is appropriate. Hydralazine and minoxidil are vasodilators. Spironolactone and amiloride are
potassium-sparing diuretics. Trichlormethiazide and hydrochlorothiazide are both thiazide
diuretics.
PTS: 1
DIF: Cognitive Level: Analysis
REF: pp. 509-510
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
14. A nursing student asks the nurse why multi-drug therapy is often used to treat hypertension.
Which statement by the student indicates a need for further teaching?
a. “Multi-drug therapy often means that drugs may be given in lower doses.”
b. “Some agents are used to offset adverse effects of other agents.”
c. “Treatment of hypertension via different mechanisms increases success.”
d. “Two or more drugs will lower blood pressure more quickly.”
ANS: D
Multi-drug therapy does not lower blood pressure more quickly. Using more than one drug
often means that doses can be decreased. Some agents can offset adverse effects of other
agents. Treatment via different mechanisms increases the likelihood of success.
PTS: 1
DIF: Cognitive Level: Comprehension
REF: pp. 509-510
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
15. A patient with a recent onset of nephrosclerosis has been taking an ACE inhibitor and a
thiazide diuretic. The patient’s initial blood pressure was 148/100 mm Hg. After 1 month of
drug therapy, the patient’s blood pressure is 130/90 mm Hg. The nurse will contact the
provider to discuss:
a. adding a calcium channel blocker to this patient’s drug regimen.
b. lowering doses of the antihypertensive medications.
c. ordering a high-potassium diet.
d. adding spironolactone to the drug regimen.
ANS: A
In patients with renal disease, the goal of antihypertensive therapy is to lower the blood
pressure to 130/80 mm Hg or less. Adding a third medication is often indicated. Lowering the
dose of the medications is not indicated because the patient’s blood pressure is not in the
target range. Adding potassium to the diet and using a potassium-sparing diuretic are
contraindicated.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 510-511
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
16. A 5-year-old patient seen in an outpatient clinic is noted to have hypertension on three
separate visits. Ambulatory blood pressure monitoring confirms that the child has
hypertension. As an initial intervention with the child’s parents, the nurse will expect to:
a. perform a detailed health history on the child.
b. provide teaching about antihypertensive medications.
c. reassure the parents that their child may outgrow this condition.
d. teach the parents about lifestyle changes and a special diet.
ANS: A
Because the incidence of secondary hypertension is much higher in children than adults, it is
important to obtain an accurate health history to help uncover primary causes. Once the type
of hypertension is established, the teaching interventions may be useful. Hypertension must be
treated, and it is incorrect to reassure parents that their child may just outgrow the condition.
PTS: 1
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
REF: p. 511
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation
17. The nurse is caring for a pregnant patient who is in labor. The woman reports having had mild
preeclampsia with a previous pregnancy. The nurse notes that the woman has a blood pressure
of 168/102 mm Hg. The nurse will contact the provider to request an order for which drug?
a. Angiotensin-converting enzyme (ACE) inhibitor
b. Hydralazine (Apresoline)
c. Magnesium sulfate
d. Sodium nitroprusside
ANS: B
The drug of choice for lowering blood pressure in a patient with severe preeclampsia is
hydralazine. Sodium nitroprusside is not indicated. Magnesium sulfate is given as prophylaxis
against seizures but does not treat hypertension. ACE inhibitors are contraindicated because of
their potential for fetal harm.
PTS: 1
DIF: Cognitive Level: Application
REF: pp. 513-514
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
18. A nurse has provided education for a patient newly diagnosed with hypertension who is just
beginning therapy with antihypertensive medications. Which statement by the patient
indicates a need for further teaching?
a. “I may experience serious long-term problems even if I am not having symptoms.”
b. “I should report side effects to the provider since other drugs may be substituted.”
c. “I will need to take medications on a long-term basis.”
d. “When my symptoms subside, I may discontinue the medications.”
ANS: D
Patients should be taught that hypertension treatment is lifelong and that medications must be
continued even when symptoms subside. Long-term problems may still occur without
symptoms. Reporting drug side effects is necessary so that other drugs may be tried if needed.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 512
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
19. A 60-year-old African American patient has a blood pressure of 120/80 mm Hg and reports a
family history of hypertension. The patient has a body mass index of 22.3. The patient reports
consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to
teach this patient?
a. Alcohol cessation
b. Potassium supplementation
c. Sodium restriction
d. Weight loss
ANS: C
Current recommendations for African Americans to prevent hypertension include sodium
restriction of less than 1500 mg/day, although this is under investigation. The patient has a
normal BMI and does not consume alcohol excessively, so weight loss and alcohol cessation
are not necessary. Potassium supplements are not indicated; patients should be advised to
consume foods high in potassium.
PTS: 1
DIF: Cognitive Level: Application
REF: p. 501
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic Adaptation