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41 Cards in this Set

  • Front
  • Back
______ blood pressure reflects the force exerted on arterial walls by blood flow.
Blood pressure normally remains constant because of _________ mechanisms that adjust blood flow to meet tissue needs.
The tow major determaninants of aterial blood pressure are ____________ (systolic pressure) and peripheral vascular resistance.
Cardiac output
______________ equals the product of the heart rate and stroke volume.
Cardiac output
_____________ is the amount of blood ejected with each heartbeat ( approximately 60 to 90 mL).
Stroke volume
Inhibit activity of the SNS
Antiadrenergic (sympatholyitc drugs)
Dilate peripheral arteries and decrease peripheral vascular resistance by relaxing vascular smooth muscle.
Calcium channel blockers
Cause antihypertensive effects usually attributed to sodium and water depletion.
Decreased heart rate, force of myocardial contraction, cardic output, and renin release from the kidneys
Beta adrenergic blocking agents
Developed to block the strong blood pressure raising effects of angiotensin II
Define and discuss auto-regulation
Autoregulation is the ability of the body tissues to regulate their own blood flow. Local blood flow is regulated primarily by nutritional needs of the tissues, such as lack of oxygen or accumulation of products of cellular metabolism such as carbon dioxide, and lactic acid. Local tissues produce vasodilation and vasoconstricting substances to regulate local blood flow. Important tissues factors include histamine, bradykinin, serotonin, and prostaglandins.
Define and discuss the action of histamines.
Histamine is found mainly in mast cells surrounding blood vessels and is released when these tissues are injured. In some tissues such as skeletal muscle, mast cell activity is mediated by the sympathetic nervous system (SNS) and histamine is released when SNS stimulation is blocked or withdrawn.
What is the role of kinins as they relate to the vascular system?
Bradykinin is released from a protein in body fluids. Kinins dilate arterioles, increase capillary permeability and constrict venules.
What is the role of serotonin as it relates to the vascular system?
Serotonin is released form aggregating platelets during the blood clotting process. It causes vascoconstriction and plays a major role in control of bleeding.
What is the role of prostaglandins as the relate to the vascular system?
Prostaglandins are formed in response to tissue injury and include vasodilators (ex prostacyclin) and vasoconstrictors (ex thromboxane)
What is the definition of hypertension?
Hypertension is persistantly high blood pressure that results from abnormalities in regulatory mechanisms. Hypertension is usually defined as a systolic pressure greater than 140mmHg or a diastolic pressure greater than 90mmHg on multiple blood pressure measurements.
Mrs. Bartley is diagnoses with secondary hypertension. What are some causes of secondary hypertension?
Secondary hypertension may result from renal, endocrine, or central nervous system disorders or from drugs that stimmulate the SNS or cause retention of sodium and water.
Mrs. Goodman is age 70 and is diagnoses with isolated systolic hypertension. What would you expect her blood pressure to be?
A systolic pressure of 140 or greater with a diastolic pressure lower than 90 is called isolated systolic hypertension and is more common in elderly.
You understand that hypertension alters cardiovascular function by increasing the workload of the heart. What does this cause?
Hypertension profoundly alters cardiovascular function by increasing the workload of the heart and causing thickening and sclerosis of arterial walls.
Mr. Magahi is diagnosed with severe hypertension. The physician prescribes minoxidil. Three months later Mr Magahi presents to the ER with angina. You are concerned because minoxidil can have which of the following effects?

a. Exacerbate angina and precipitate effusion.

b. Cause rebound hypertention when a dose is missed.

c. Precipitate cardiovascular accidents.

d. Exacerbate pancreatitis

Rationale: The FDA has issued a black box warning for minoxidil, becase the drug an exacerbate angina and precipitate effusion ( which can progress to cardiac tamponade).
Mrs. Gorgan age 35 controls the symptoms of her cardiovascular disease with ACE inhibitors. She discovers that she is pregnant and contacts her physician regarding her medication regimen. WHich of the following would you expect the physician to do?

a. Discontinue the drug

b. Increase the dosage of the drug.

c. Decrease the dosage of the drug

d. Maintain the current dosage of the drug.

Rationale: The FDA has issued a black box warning for ACE inhibitors and ARB's during pregnancy, because their use can cause injury and even death to a developing fetus.
Mr. Frank's friend tells him to stop taking this metoprolol because he read that it causes cancer. You encourage the client to consult his physician because abrupt withdrawal from the drug may cause with of the following effects?

a. Postural hypotension and falls.

b. Bradycardia

c. Exacerbation of his angina

d. Atrial dysrhythmias

Ratoinale: The FDA has issued a black box warning for patient with CAD who are withdrawing from oral forms of atenolol, metoprolol, nadolol, propranolol, and timolol; abrupt withdrawal has resulted in exacerabtion of angina, increased incidence of ventricular dysrhythmias, and occurrence of MI's.
African Americans are more likely to have severe hypertension and to require multiple drugs, for which of the following reasons? ( Select all that apply)

a. Low circulating renin

b. Increased salt sensitivity

c. A higher incidence of obesity

d. Increased potassium sensitivity.
a, b, c

Rationale: African Americans are more likely to have severe hypertension and to requiremultiple drugs as a result of having low circulating renin, increased salt sensitivity and higher incidence of obesity.
Mr. Yu an asian executive visiting the US presents to the ER with a severe headache and an elevated BP. He is admited to the hospital for his medication regimen. The client is concerned because the dosage prescribed for his antihypertensive medication is lower than what he researched on the internet. Which of the following is an accurate response for you to make?

a. There is an error on the prescription.

b. I will contact the physician immediately.

c. People of asian descent excrete the drugs more rapidly, so the doses prescribed are smaller.

d. People of Asian descent excrete the drugs more slowly so the doses are prescribed are smaller.

Rationale: In general individuals of asian descent with hypertension require much smaller doses of beta blockers because the metabolize and excrete the drugs slowly.
Mr. Jones age 45 is diagnosed with high renin hypertension. Which of the following types of drugs would you expect the physician to order?

a. Ace inhibitors

b. Beta Blockers

c. Diuretics

d. Calcium channel blockers

Rationale: Beta adrenergic blockers are the drugs of choice for patients younger than 50yrs of age who have high renin hypertension tachycardia angina petoris; MI; or left ventricular hypertrophy.
Ace inhibitors and ______ are equally effective at controlling blood pressure
You instruct Mr. Montgomery to administer his alph1 adrenergic receptro blocking agent at hight. Which of the following does this practice help to minimize?

a. Postural hypertension

b. First Dose phenomenon

c. Hypoglycemic reaction.

d. Hyperglycemia reaction.

Rationale: Alpha 1 adrenergic receptor blocking agents should be administer at bedtime to minimize the first dose phenomenon.
Key behavioral determinants of blood pressure are related to which of the following factors?

a. Minimal body mass

d. Dietary consumption of calories and salt.

c. Dietary consumption of sugars and fat.

d. Comorbidites

Rationale: Key behavioral determinants of blood presssure are related to dietary consumption of calories and salt; the prevalence of hypertension rises proportionally to average body mass index.
Mr. Solomon, age 57 presents to the physicians office for the second consecutive month with an elevated blood pressure. His hypertension has been successfully managed with his current drug history, he states that the only new drug drug is the herb yohimbe. What is yohimbe?

a. An OCT antihyperglycemic

b. A central nervous system stimulant.

c. An autonomic nervouse system stimulant .

d. Diuretic

Rationale: Yohimbe used to treat erectile dysfunction is a central nervous system stimulant and can affect blood pressure.
Found mainly in mast cells surrounding blood vessels and is released when these tissues are injured. Medicated by the SNS and is released when SNS stimulation is blocked or withdrawn. Vasodilation results from increased histamine release and the withdrawal of SNS vasoconstrictor activity.
released from a protein in body fluids.
released from aggregating platelets during the blood clotting process. It causes vasoconstriction and plays a major role in control of bleeding.
formed in response to tissue injury and including vasodilators (prostacyclin) and vasoconstrictors (thromboxane A2).
True or false?

Vasodilating substances, which decrease vascular tone and blood pressure, include nitric oxide and prostacyclin.
True or false?

Excessive vasoconstrictors or deficient vasodilators may contribute to the development of atherosclerosis, hypertension, and other diseases.
______________ regulation of blood pressure mainly involves the SNS, which controls heart rate and force of contraction.
Whether the patient or another member of the household is taking antihypertensive medications the home care nurse may be helpful in which of hte following tasks?
Monitoruing for drug effects
Promoting compliance with the prescribed pharmacologic modifications
Promoting compliance with the prescribed lifestyle modifictions
A pt presents to the ER in hypertensive crisis. You anticipate that the physician will order medication that will lower the blood pressure yet prevent stroke, MI and acute renal failure within what period of time?
Over several minutes to several hours.
Mr. Grant is admitted to your CCU with severe hypertension and myocardial ischemia. The physician orders nitroglycerin titrated according to what factor?
Blood pressure response.
Mr. Brands presents to the ER with a significant elevated BP. They physician chooses oral captopril for treatment. Why?
Urgencies can be treated with oral anit hypertensive agents such as captopril 25 to 50mg every 1 to 2hrs or clonidine 0.2mg initially and them 0.1mg hourly until the diastolic blood pressure falls to less than 110mmHg or 0.7mg has been given.
True or false?

Patients who have jaundice or marked elevations of hepatic enzymes while taking ACE inhibitors should have the drug discontiuted because these drugs have been associated with cholestatic jaundice which can progress to hepatic necrosis and possibly death.